PRESS STATEMENT FOR IMMEDIATE RELEASE
May 16, 2023
Contact: Peter W. Thomas, ITEM Coalition Coordinator – Peter.Thomas@powerslaw.com | 202-607-5780
National Coverage Determination Released; Enthusiastically Applauded by Disability and Rehabilitation Community
Washington, D.C. – Today, the Centers for Medicare and Medicaid Services (CMS) published a landmark National Coverage Decision (NCD) for Medicare coverage of seat elevation systems in power wheelchairs. The Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition submitted this coverage request and commends the Biden Administration for recognizing seat elevation systems as important for Medicare beneficiaries with mobility impairments who need seat elevation to perform daily activities and live as independently as possible.
CMS’s preliminary decision, announced in mid-February, determined for the first time that seat elevation is not a convenience item and is, in fact, “primarily medical in nature.” The agency proposed to cover seat elevation under the durable medical equipment (DME) benefit and deemed it reasonable and necessary for beneficiaries who, due to a mobility impairment, need seat elevation in a Group 3 Complex Rehabilitative Technology (CRT) power wheelchair in order to transfer from one surface to another. Coverage is linked to the ability to perform or participate in mobility related activities of daily living (MRADLs) in the home. The ITEM Coalition supported this decision but urged CMS to expand this proposed coverage, as did the vast majority of the 2,130 comments submitted to CMS by members of the public.
In the final NCD issued today, CMS decided to cover seat elevation in all power wheelchairs for the purposes of performing all transfers or to improve reach in performing MRADLs in their homes. This is a major expansion of coverage from the preliminary coverage decision announced in mid-February, and CMS attributed these coverage improvements to the public comments received by wheelchair users, advocates, clinicians, and researchers. The final seat elevation Decision Memo can be viewed HERE.
“The ITEM Coalition and disability stakeholders are thrilled that CMS seriously considered the input from wheelchair users, allies, and experts in the field who requested an expansion of the preliminary coverage decision,” stated Peter W. Thomas, J.D., coordinator of the ITEM Coalition. “The final NCD is a significant victory for the disability community that we expect will have ripple effects with other health care payers.”
Increasing access to these systems will provide beneficiaries with more independence to perform daily activities and avoid countless complications and secondary medical conditions. The Medicare program previously did not provide coverage of seat elevation systems because Medicare contractors in 2005 determined, with no supporting clinical evidence, that they are not “primarily medical in nature” and, therefore, not included in the DME benefit. The ITEM Coalition has long advocated for coverage due to the indisputable medical benefits of power seat elevation, especially for non-ambulatory beneficiaries. In September 2020, the ITEM Coalition submitted a formal NCD Reconsideration Request to CMS asking the agency to consider coverage of both seat elevation and standing systems in CRT power wheelchairs.
“We are grateful to CMS for establishing—and expanding—coverage for this critical technology for people with paralysis and other mobility disabilities,” stated Alexandra Bennewith of United Spinal Association. “For far too long, Medicare has considered seat elevation a convenience or luxury. We look forward to the day when enhanced coverage for critical devices and technologies that improve quality of life, extend function, and lead to greater community independence are available and accessible to the millions of people with mobility disabilities across the United States.”
Public support of CMS coverage of seat elevation systems is extensive and unwavering. During the public comment period for the NCD, CMS received 2,130 separate and unique comments from Medicare beneficiaries with mobility impairments, rehabilitation therapists who address the mobility device needs of beneficiaries, physicians who treat this patient population, rehabilitation hospitals, seating clinics, researchers, manufacturers and suppliers, and the general public. These comments were unanimous in their support of Medicare coverage for seat elevation systems. To prepare comments for the proposed NCD, the ITEM Coalition convened dozens of experts, including power wheelchair users, to prepare a comprehensive response to the proposal.
“I treat patients who need access to power seat elevation systems in their power wheelchair daily in my clinical practice. Expanding access to these systems under Medicare will improve the health, function, and quality of life for many of my patients, allowing them to live more independently,” stated Anjali Shah, M.D., a board-certified Physical Medicine and Rehabilitation specialist, Director of Wheelchair and Seating at UT Southwestern Medical Center, and member of the American Academy of Physical Medicine and Rehabilitation (AAPM&R). Cara Masselink, OTRL, Ph.D., ATP of the Clinician Task Force added, “The evidence base clearly establishes that seat elevation is a medical benefit that will greatly improve function and health for Medicare patients with mobility impairments and reduce the incidence of secondary injury due to long-term power wheelchair use.”
“As a quadriplegic, my seat elevation system has greatly improved my independence and quality of life” said Ali Ingersoll, an advocate with the Christopher & Dana Reeve Foundation. “I am now able to raise myself up to cook food on the stove safely, brush my teeth at the sink, and safely transfer at a level surface to my bed, among numerous other benefits. Most importantly, the ability to perform these daily functions independently greatly reduces my risk for secondary complications such as pressure sores and broken bones due to falls from transferring to and from uneven surfaces. In short, the seat elevation system in my power chair has made me a more independent and more productive member of my community.”
The ITEM Coalition eagerly awaits an NCD for standing systems. CMS elected to split the seat elevation and standing systems into separate NCDs, evaluating only seating elevation during this NCD process and declining to set a schedule for reviewing standing systems pending further consideration.
The ITEM Coalition is a national consumer and clinician-led coalition advocating for access to and coverage of assistive devices, technologies, and related services for persons with injuries, illnesses, disabilities, and chronic conditions of all ages. Its members represent individuals with a wide range of disabling conditions, as well as the providers who serve them, including multiple sclerosis, spinal cord injury, brain injury, stroke, paralysis, limb loss and limb difference, cerebral palsy, spina bifida, hearing, speech, and visual impairments, myositis, and other life-altering conditions. For more information, visit https://www.itemcoalition.org/ or www.Rise4Access.org.
Please contact Peter Thomas, ITEM Coalition coordinator, for more information at 202-607-5780 or at Peter.Thomas@PowersLaw.com